Dr. Shelly Vaziri Flais, M.D., F.A.A.P., is a pediatrician with Pediatric Health Associates of Naperville, Plainfield and West Chicago. She is the author of "Raising Twins, From Pregnancy to Preschool -- Advice from a Pediatrician Mom of Twins," published by the American Academy of Pediatrics. We asked her for a little advice regarding children's bedtimes.
Q. Do pediatricians believe there are "age-appropriate" bedtimes?
Dr. Flais: A child's overall sleep pattern, and the total hours of sleep duration, are more important for health and development than what the specific hour bedtime is -- and yes, there are age-appropriate guidelines for proper sleep amounts.
That being said, while there is no one perfect "bedtime," it is a very good idea to maintain your family's chosen bedtime as consistently as possible, so your kids adjust to the sleep pattern well.
Parents should ensure that their child is getting an appropriate amount of sleep during each 24-hour day, and this includes both overnight sleep and daytime naps. Typically, newborns require 14-16 hours of sleep each 24-hour day; however these hours are often split evenly between overnight and daytime hours.
As your infant grows, the goal is longer stretches of overnight sleep and a more scheduled daytime nap schedule. By the 1st birthday, children usually require 12-14 hours of sleep over 24 hours, which includes two daytime naps, and by the 2nd birthday are taking one main nap in the early afternoon. A 10-year-old should be getting about 9-10 hours of sleep each night.
A good bedtime routine, when followed consistently, cues a child that it is soon time to sleep. The ideal bedtime routine occurs BEFORE a child shows signs of being overtired or cranky.
Q. Should bedtimes be based on biology -- meaning the inner "clock" of children at various ages -- or on what's best for the family? (For instance, what would you tell a parent who works an odd shift and can only see his child late at night or early in the morning?)
Dr. Flais: There is a way to be respectful to your child's age appropriate sleep needs while making tweaks to allow for more family time given the parent's work schedules or family situation. Family meals and family time are important, and there are ways to creatively work with a parent's odd working hours. Breakfast can become the main family meal of the day instead of the typical "family dinner".
The point is gathering as a family over a meal on a regular basis as much as possible. Often working parents continue their child's afternoon nap for a longer time so as to have pleasant family time together in the evenings. A modified schedule can also come into play for families with multiple children of various ages. Even if one parent is able to stay at home with the children, if the baby has older siblings who need to be driven to school or to various activities, this will impact the child's daytime nap schedule.
Q, Do you have tips on how to make bedtime routine?
Dr. Flais: For infants and younger children through preschool, a good general rule of thumb is dinner followed by some quiet playtime (no television, too stimulating), followed by a consistent bedtime routine. An example of a good routine is brushing teeth, bath time, pajamas, reading a story, tuck in bed and lights out. With a consistent pattern each step of bedtime will help "cue" the child that it is soon time for sleep. A sip of water at bedtime is fine but preschoolers may "test" parents by asking for "one more glass" to prolong bedtime; be firm and consistent in your response and your child will learn appropriate bedtime behavior.
Q. A co-worker's 2½-year-old doesn't nap at school any longer, and when she comes home dinner can be a problem because she's tired and cranky. Any tips?
Dr. Flais: I advise families to not allow their child to give up the daytime nap "cold-turkey." I recommend a transition to an hour of "quiet time" -- the child does not need to be sleeping (but early on after giving up the nap, may fall asleep every other day or even every third day), but should either rest quietly or sit with picture books for an hour. The environment for the hour of quiet time should be as calm as possible, and definitely no television.
Q. What's the best way to handle a baby who is overtired and can't get herself to sleep?
Dr. Flais: An overtired baby, ironically, will have a more difficult time falling asleep, because her stress response will kick in, preventing her from resting peacefully. We pediatricians often say "sleep begets more sleep," meaning better daytime nappers fall asleep more easily at bedtime. Times of illness or travel will impact the usual sleep pattern, but be as respectful of a nap schedule and bedtime as possible to prevent your child from getting overtired.
Q. Can you recommend any books or articles on bedtimes?
Dr. Flais: I strongly recommend these books, both written by pediatricians, to families in my practice:
Dr. Richard Ferber, "Solve Your Child's Sleep Problems" has wonderful charts for appropriate amounts of sleep for various ages; and Dr. Marc Weissbluth's "Healthy Sleep Habits, Happy Child."